Traumatic Brain Injury 153at any technique to help their loved ones (Gillis, 1996), but false hope and unrealistic expectations
should not be created.
Rehabilitation of patients with traumatic brain injuries involves the team approach. The
primary team members usually include attending physicians, physiatrists (specialists in physi-
cal medicine and rehabilitation), nurses, dietitians, neuropsychologists, social workers, speech-
language pathologists, and occupational and physical therapists. Other specialists, such as psy-
chiatrists, pediatric neurologists, gerontologists, music therapists, and rehabilitation counselors,
may be called on to join the team, depending on case- specific requirements. According to Mackay
et al. (1997), patients with traumatic brain injury should also be seen by an audiologist to establish
the likelihood of damage to auditory structures.
With regard to communication, there are two primary treatment foci for patients with trau-
matic brain injuries. First, the patient’s mental executive functioning and metacognition abilities
are addressed to improve his or her be hav ior, memory, orientation, and learning. Real ity orien-
tation is a procedure used in many rehabilitation facilities to achieve these goals. In it, all team
members tell the patient the time and date, the reason for seeing the patient, and other pertinent
information. The goal is to provide ongoing, consistent information to help the patient re orient
to the new circumstances. The team, including the patient’s family, also works on behavioral
objectives, which include rewarding appropriate be hav iors and discouraging inappropriate ones.
Consistency is impor tant in the rehabilitation of traumatic brain- injured persons, and the team
meets regularly to plan goals and objectives, provide treatments, and monitor outcomes.
The second focal area is the specific neurogenic communication disorder. Patients with dys-
arthria are given the appropriate neuromuscular therapies to improve respiration, phonation,
articulation, resonance, and prosody. Apraxia of speech therapy improves motor speech con-
ceptualization, programming, and planning. Aphasia therapies address expressive and receptive
language deficits in all affected modalities. The therapies for neurogenic communication disorders
in patients who also have metacognition and mental executive functioning deficits require special
modifications for their memory, orientation, and behavioral prob lems.
Case Study 8-1: Open Head Injury After a Suicide Attempt
For Candace, a high school ju nior, her first love was like a wild roller- coaster ride filled with
the euphoria of young, passionate love and, in the end, the desperation and pain of rejection.
Brief ly, it was the best and the worst of times. Tragically, Candace’s first love ended in a suicide
attempt and a severe traumatic brain injury due to a self- inf licted gunshot wound to the head. A
cheating boyfriend, drunkenness, and the anguish of rejection forever changed her life and the
lives of her family and friends.
Candace was born on a large cattle ranch in the picturesque Teton Mountain Range of
Wyoming. An only child, she had doting parents and grew to love horses and the wide- open
spaces. Ranch work is hard, but Candace gladly accepted the responsibilities of tending to suck-
ling calves and bum lambs. She had little time for school activities, given her after- school chores
and the need to care for abandoned animals. An honor student, Candace was popu lar with her
schoolmates and had typical “puppy loves” and infatuations. Then, in her ju nior year, one of the
“bad boys” at school stole her heart. Her parents forbade the relationship, which seemed to make
it all the more special. For several months, their love grew and blossomed.